Provider Demographics
NPI:1285973016
Name:ANN B PATTERSON MD PC
Entity type:Organization
Organization Name:ANN B PATTERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-634-6646
Mailing Address - Street 1:721 W 13TH ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1855
Mailing Address - Country:US
Mailing Address - Phone:812-634-6646
Mailing Address - Fax:812-634-2104
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:SUITE 322
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1855
Practice Address - Country:US
Practice Address - Phone:812-634-6646
Practice Address - Fax:812-634-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047312261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1356310627OtherNPI TYPE I
IN200227520AMedicaid
IN1356310627OtherNPI TYPE I